1
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Marshall BP, Ashinsky BG, Ferrer XE, Kunes JA, Innis AC, Luzzi AJ, Forrester LA, Burt KG, Lee AJ, Song L, Lisiewski LE, Soni RK, Hung CT, Levine WN, Kovacevic D, Thomopoulos S. The subacromial bursa modulates tendon healing after rotator cuff injury in rats. Sci Transl Med 2024; 16:eadd8273. [PMID: 38657023 DOI: 10.1126/scitranslmed.add8273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Rotator cuff injuries result in more than 500,000 surgeries annually in the United States, many of which fail. These surgeries typically involve repair of the injured tendon and removal of the subacromial bursa, a synovial-like tissue that sits between the rotator cuff and the acromion. The subacromial bursa has been implicated in rotator cuff pathogenesis and healing. Using proteomic profiling of bursa samples from nine patients with rotator cuff injury, we show that the bursa responds to injury in the underlying tendon. In a rat model of supraspinatus tenotomy, we evaluated the bursa's effect on the injured supraspinatus tendon, the uninjured infraspinatus tendon, and the underlying humeral head. The bursa protected the intact infraspinatus tendon adjacent to the injured supraspinatus tendon by maintaining its mechanical properties and protected the underlying humeral head by maintaining bone morphometry. The bursa promoted an inflammatory response in injured rat tendon, initiating expression of genes associated with wound healing, including Cox2 and Il6. These results were confirmed in rat bursa organ cultures. To evaluate the potential of the bursa as a therapeutic target, polymer microspheres loaded with dexamethasone were delivered to the intact bursae of rats after tenotomy. Dexamethasone released from the bursa reduced Il1b expression in injured rat supraspinatus tendon, suggesting that the bursa could be used for drug delivery to reduce inflammation in the healing tendon. Our findings indicate that the subacromial bursa contributes to healing in underlying tissues of the shoulder joint, suggesting that its removal during rotator cuff surgery should be reconsidered.
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Affiliation(s)
- Brittany P Marshall
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Beth G Ashinsky
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Xavier E Ferrer
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Jennifer A Kunes
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Astia C Innis
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Andrew J Luzzi
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Lynn Ann Forrester
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Kevin G Burt
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Andy J Lee
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Lee Song
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Lauren E Lisiewski
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Rajesh K Soni
- Proteomics and Macromolecular Crystallography Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Clark T Hung
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - David Kovacevic
- New York Metropolitan Orthopaedics and Spine, New York, NY 10001, USA
| | - Stavros Thomopoulos
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
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2
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Song L, Golman M, Abraham AC, Zelzer E, Thomopoulos S. A role for TGFβ signaling in Gli1+ tendon and enthesis cells. FASEB J 2024; 38:e23568. [PMID: 38522021 PMCID: PMC10962263 DOI: 10.1096/fj.202301452r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/16/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
The development of musculoskeletal tissues such as tendon, enthesis, and bone relies on proliferation and differentiation of mesenchymal progenitor cells. Gli1+ cells have been described as putative stem cells in several tissues and are presumed to play critical roles in tissue formation and maintenance. For example, the enthesis, a fibrocartilage tissue that connects tendon to bone, is mineralized postnatally by a pool of Gli1+ progenitor cells. These cells are regulated by hedgehog signaling, but it is unclear if TGFβ signaling, necessary for tenogenesis, also plays a role in their behavior. To examine the role of TGFβ signaling in Gli1+ cell function, the receptor for TGFβ, TbR2, was deleted in Gli1-lineage cells in mice at P5. Decreased TGFβ signaling in these cells led to defects in tendon enthesis formation by P56, including defective bone morphometry underlying the enthesis and decreased mechanical properties. Immunohistochemical staining of these Gli1+ cells showed that loss of TGFβ signaling reduced proliferation and increased apoptosis. In vitro experiments using Gli1+ cells isolated from mouse tail tendons demonstrated that TGFβ controls cell proliferation and differentiation through canonical and non-canonical pathways and that TGFβ directly controls the tendon transcription factor scleraxis by binding to its distant enhancer. These results have implications in the development of treatments for tendon and enthesis pathologies.
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Affiliation(s)
- Lee Song
- Department of Orthopedic Surgery, Columbia University, New York, NY10032, USA
| | - Mikhail Golman
- Department of Orthopedic Surgery, Columbia University, New York, NY10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY10027, USA
| | - Adam C. Abraham
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Israel
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY10027, USA
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3
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Luzzi AJ, Ferrer X, Fang F, Golman M, Song L, Marshall BP, Lee AJ, Kim JJ, Hung CT, Thomopoulos S. Hedgehog Activation for Enhanced Rotator Cuff Tendon-to-Bone Healing. Am J Sports Med 2023; 51:3825-3834. [PMID: 37897335 PMCID: PMC10821775 DOI: 10.1177/03635465231203210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
BACKGROUND Rotator cuff repair is a common orthopaedic procedure, yet the rate of failure to heal after surgery is high. Repair site rupture is due to poor tendon-to-bone healing and lack of regeneration of the native fibrocartilaginous enthesis. During development, the enthesis is formed and mineralized by a pool of progenitors activated by hedgehog signaling. Furthermore, hedgehog signaling drives regenerative enthesis healing in young animals, in contrast to older animals, in which enthesis injuries heal via fibrovascular scar and without participation of hedgehog signaling. HYPOTHESIS Hedgehog activation improves tendon-to-bone healing in an animal model of rotator cuff repair. STUDY DESIGN Controlled laboratory study. METHODS A total of 78 adult Sprague-Dawley rats were used. Supraspinatus tendon injury and repair were completed bilaterally, with microsphere-encapsulated hedgehog agonist administered to right shoulders and control microspheres administered to left shoulders. Animals were sacrificed after 3, 14, 28, or 56 days. Gene expression and histological, biomechanical, and bone morphometric analyses were conducted. RESULTS At 3 days, hedgehog signaling pathway genes Gli1 (1.70; P = .029) and Smo (2.06; P = .0173), as well as Runx2 (1.69; P = .0386), a transcription factor of osteogenesis, were upregulated in treated relative to control repairs. At 14 days, transcription factors of tenogenesis, Scx (4.00; P = .041), and chondrogenesis, Sox9 (2.95; P = .010), and mineralized fibrocartilage genes Col2 (3.18; P = .031) and Colx (1.85; P = .006), were upregulated in treated relative to control repairs. Treatment promoted fibrocartilage formation at the healing interface by 28 days, with improvements in tendon-bone maturity, organization, and continuity. Treatment led to improved biomechanical properties. The material property strength (2.43 vs 1.89 N/m2; P = .046) and the structural property work to failure (29.01 vs 18.09 mJ; P = .030) were increased in treated relative to control repairs at 28 days and 56 days, respectively. Treatment had a marginal effect on bone morphometry underlying the repair. Trabecular thickness (0.08 vs 0.07 mm; P = .035) was increased at 28 days. CONCLUSION Hedgehog agonist treatment activated hedgehog signaling at the tendon-to-bone repair site and prompted increased mineralized fibrocartilage production. This extracellular matrix production and mineralization resulted in improved biomechanical properties, demonstrating the therapeutic potential of hedgehog agonism for improving tendon-to-bone healing after rotator cuff repair. CLINICAL RELEVANCE This study demonstrates the therapeutic potential of hedgehog agonist treatment for improving tendon-to-bone healing after rotator cuff injury and repair.
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Affiliation(s)
- Andrew J. Luzzi
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Xavier Ferrer
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Fei Fang
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Mikhail Golman
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Lee Song
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Brittany P. Marshall
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Andy J. Lee
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Jieon J. Kim
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Clark T. Hung
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
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4
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Lake SP, Snedeker JG, Wang VM, Awad H, Screen HRC, Thomopoulos S. Guidelines for ex vivo mechanical testing of tendon. J Orthop Res 2023; 41:2105-2113. [PMID: 37312619 PMCID: PMC10528429 DOI: 10.1002/jor.25647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Tendons are critical for the biomechanical function of joints. Tendons connect muscles to bones and allow for the transmission of muscle forces to facilitate joint motion. Therefore, characterizing the tensile mechanical properties of tendons is important for the assessment of functional tendon health and efficacy of treatments for acute and chronic injuries. In this guidelines paper, we review methodological considerations, testing protocols, and key outcome measures for mechanical testing of tendons. The goal of the paper is to present a simple set of guidelines to the nonexpert seeking to perform tendon mechanical tests. The suggested approaches provide rigorous and consistent methodologies for standardized biomechanical characterization of tendon and reporting requirements across laboratories.
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Affiliation(s)
- Spencer P. Lake
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Vincent M. Wang
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Hani Awad
- Department of Orthopaedics, Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Hazel R. C. Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, UK
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
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5
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Lane RA, Migotsky N, Havlioglu N, Iannucci LE, Shen H, Lake S, Sakiyama-Elbert SE, Thomopoulos S, Gelberman RH. The effects of NF-κB suppression on the early healing response following intrasynovial tendon repair in a canine model. J Orthop Res 2023; 41:2295-2304. [PMID: 37094977 PMCID: PMC10524774 DOI: 10.1002/jor.25576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
The highly variable clinical outcomes noted after intrasynovial tendon repair have been associated with an early inflammatory response leading to the development of fibrovascular adhesions. Prior efforts to broadly suppress this inflammatory response have been largely unsuccessful. Recent studies have shown that selective inhibition of IkappaB kinase beta (IKK-β), an upstream activator of nuclear factor kappa-light chain enhancer of activated B cells (NF-κB) signaling, mitigates the early inflammatory response and leads to improved tendon healing outcomes. In the current study, we test the hypothesis that oral treatment with the IKK-β inhibitor ACHP (2-amino-6-[2-(cyclopropylmethoxy)-6-hydroxyphenyl]-4-piperidin-4-yl nicotinenitrile an inhibitor) will modulate the postoperative inflammatory response and improve intrasynovial flexor tendon healing. To test this hypothesis, the flexor digitorum profundus tendon of 21 canines was transected and repaired within the intrasynovial region and assessed after 3 and 14 days. Histomorphometry, gene expression analyses, immunohistochemistry, and quantitative polarized light imaging were used to examine ACHP-mediated changes. ACHP led to reduction in phosphorylated p-65, indicating that NF-κB activity was suppressed. ACHP enhanced expression of inflammation-related genes at 3 days and suppressed expression of these genes at 14 days. Histomorphometry revealed enhanced cellular proliferation and neovascularization in ACHP-treated tendons compared with time-matched controls. These findings demonstrate that ACHP effectively suppressed NF-κB signaling and modulated early inflammation, leading to increased cellular proliferation and neovascularization without stimulating the formation of fibrovascular adhesions. Together, these data suggest that ACHP treatment accelerated the inflammatory and proliferative phases of tendon healing following intrasynovial flexor tendon repair. Clinical Significance: Using a clinically relevant large-animal model, this study revealed that targeted inhibition of nuclear factor kappa-light chain enhancer of activated B cells signaling with ACHP provides a new therapeutic strategy for enhancing the repair of sutured intrasynovial tendons.
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Affiliation(s)
- Ryan A. Lane
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Nicole Migotsky
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA
| | - Necat Havlioglu
- Department of Pathology, John Cochran VA Medical Center, St Louis, Missouri, USA
| | - Leanne E. Iannucci
- Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Spencer Lake
- Mechanical Engineering & Materials Science, Washington University, St Louis, Missouri, USA
| | | | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Richard H. Gelberman
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
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6
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Little D, Amadio PC, Awad HA, Cone SG, Dyment NA, Fisher MB, Huang AH, Koch DW, Kuntz AF, Madi R, McGilvray K, Schnabel LV, Shetye SS, Thomopoulos S, Zhao C, Soslowsky LJ. Preclinical tendon and ligament models: Beyond the 3Rs (replacement, reduction, and refinement) to 5W1H (why, who, what, where, when, how). J Orthop Res 2023; 41:2133-2162. [PMID: 37573480 PMCID: PMC10561191 DOI: 10.1002/jor.25678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
Several tendon and ligament animal models were presented at the 2022 Orthopaedic Research Society Tendon Section Conference held at the University of Pennsylvania, May 5 to 7, 2022. A key objective of the breakout sessions at this meeting was to develop guidelines for the field, including for preclinical tendon and ligament animal models. This review summarizes the perspectives of experts for eight surgical small and large animal models of rotator cuff tear, flexor tendon transection, anterior cruciate ligament tear, and Achilles tendon injury using the framework: "Why, Who, What, Where, When, and How" (5W1H). A notable conclusion is that the perfect tendon model does not exist; there is no single gold standard animal model that represents the totality of tendon and ligament disease. Each model has advantages and disadvantages and should be carefully considered in light of the specific research question. There are also circumstances when an animal model is not the best approach. The wide variety of tendon and ligament pathologies necessitates choices between small and large animal models, different anatomic sites, and a range of factors associated with each model during the planning phase. Attendees agreed on some guiding principles including: providing clear justification for the model selected, providing animal model details at publication, encouraging sharing of protocols and expertise, improving training of research personnel, and considering greater collaboration with veterinarians. A clear path for translating from animal models to clinical practice was also considered as a critical next step for accelerating progress in the tendon and ligament field.
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Affiliation(s)
- Dianne Little
- Department of Basic Medical Sciences, The Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Peter C Amadio
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hani A Awad
- Department of Orthopaedics, Department of Biomedical Engineering, The Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
| | - Stephanie G Cone
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Nathaniel A Dyment
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University-University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Alice H Huang
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Drew W Koch
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrew F Kuntz
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rashad Madi
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Lauren V Schnabel
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Snehal S Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Chunfeng Zhao
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Marshall BP, Ferrer XE, Kunes JA, Innis AC, Luzzi AJ, Forrester LA, Burt KG, Lee AJ, Song L, Hung CT, Levine WN, Kovacevic D, Thomopoulos S. The subacromial bursa is a key regulator of the rotator cuff and a new therapeutic target for improving repair. bioRxiv 2023:2023.07.01.547347. [PMID: 37425730 PMCID: PMC10327214 DOI: 10.1101/2023.07.01.547347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Rotator cuff injuries result in over 500,000 surgeries performed annually, an alarmingly high number of which fail. These procedures typically involve repair of the injured tendon and removal of the subacromial bursa. However, recent identification of a resident population of mesenchymal stem cells and inflammatory responsiveness of the bursa to tendinopathy indicate an unexplored biological role of the bursa in the context of rotator cuff disease. Therefore, we aimed to understand the clinical relevance of bursa-tendon crosstalk, characterize the biologic role of the bursa within the shoulder, and test the therapeutic potential for targeting the bursa. Proteomic profiling of patient bursa and tendon samples demonstrated that the bursa is activated by tendon injury. Using a rat to model rotator cuff injury and repair, tenotomy-activated bursa protected the intact tendon adjacent to the injured tendon and maintained the morphology of the underlying bone. The bursa also promoted an early inflammatory response in the injured tendon, initiating key players in wound healing. In vivo results were supported by targeted organ culture studies of the bursa. To examine the potential to therapeutically target the bursa, dexamethasone was delivered to the bursa, prompting a shift in cellular signaling towards resolution of inflammation in the healing tendon. In conclusion, contrary to current clinical practice, the bursa should be retained to the greatest extent possible and provides a new therapeutically target for improving tendon healing outcomes. One Sentence Summary The subacromial bursa is activated by rotator cuff injury and regulates the paracrine environment of the shoulder to maintain the properties of the underlying tendon and bone.
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8
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Marshall BP, Levine WN, Thomopoulos S. The Role of the Subacromial Bursa in Rotator Cuff Healing: Friend or Foe? J Bone Joint Surg Am 2023; 105:417-425. [PMID: 36575165 PMCID: PMC10353884 DOI: 10.2106/jbjs.22.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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9
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Hoppe ED, Birman V, Kurtaliaj I, Guilliams CM, Pickard BG, Thomopoulos S, Genin GM. A discrete shear lag model of the mechanics of hitchhiker plants, and its prospective application to tendon-to-bone repair. Proc Math Phys Eng Sci 2023. [DOI: 10.1098/rspa.2022.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Tendon-to-bone repairs often fail when sutures pull through tendon, like a wire through cheese. Repair strength is maximized when loads are balanced equally among all sutures, relative to the pullout resistance of the tendon and the strength of the sutures. This problem of balancing loads across multiple, discrete attachment sites has been solved in nature by hitchhiker plants that proliferate by adhering relatively stiff fruit to relatively soft fur and fabrics through arrays of hooks. We, therefore, studied the fruits of such a plant,
Harpagonella palmeri
, and developed a discrete shear lag analysis of the force distributions in
H. palmeri
's linear arrays of long, slender hooks of varied lengths and spacing. Results suggested that strategies were used by the plant to distribute loads, including variations in the spacing and stiffnesses of hooks that serve to equalize forces over attachment sites. When applying these models to suturing schemes for surgical reattachment of tendon to bone, results suggested that strategies exhibited by
H. palmeri
show promise for balancing forces over sutures, potentially doubling repair strength relative to what could be achieved with a uniform suture distribution. Results suggest a potential pathway for strengthening surgical repairs, and more broadly for optimizing fasteners for bi-material attachment.
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Affiliation(s)
- Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, Rolla, MO
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | | | - Barbara G. Pickard
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
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10
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Gelberman RH, Lane RA, Sakiyama-Elbert SE, Thomopoulos S, Shen H. Metabolic regulation of intrasynovial flexor tendon repair: The effects of dichloroacetate administration on early tendon healing in a canine model. J Orthop Res 2023; 41:278-289. [PMID: 35488732 PMCID: PMC9617806 DOI: 10.1002/jor.25354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Enriched in glycolytic enzymes, paucicellular and hypovascular intrasynovial flexor tendons fail to mount an effective healing response after injury and repair. In contrast, well-vascularized extrasynovial flexor tendons possess high levels of oxidative phosphorylation (OXPHOS) enzymes and have a markedly improved healing capacity. This study was designed to compare the metabolic profiles of the two types of tendons and to evaluate the impact of metabolic reprogramming on early intrasynovial tendon healing in a clinically relevant canine model. Results showed that healthy intrasynovial tendons expressed higher levels of PDK1 and GAPDH and lower levels of SCX and IGF1 than did extrasynovial tendons. PDK1 encodes a subtype of pyruvate dehydrogenase kinase (PDK) that inhibits OXPHOS. Consistently, ATP production via glycolysis was favored in intrasynovial tendon cells whereas OXPHOS was the preferred pathway in extrasynovial tendon cells. Inhibition of glycolysis in vitro increased SCX expression in intrasynovial tendon cells. Therefore, dichloroacetate (DCA), a PDK1 inhibitor, was used in vivo to shift intrasynovial tendon ATP production from glycolysis to OXPHOS. Oral DCA administration reduced serum lactate concentration and increased acetyl-CoA content in repaired intrasynovial tendons and led to reduced TLR4 and IL1B and increased IGF1, SCX, and TGFB3 expressions in treated intrasynovial tendons compared to controls. Immunohistochemistry staining with anti-Ki67 and anti-CD31 antibodies revealed marked increases in cellularity and neovascularization in treated intrasynovial tendons. Clinical significance: The findings of this experiment indicate that improved gene expression and histological outcomes can be achieved by regulating glucose metabolism in the early stages following intrasynovial tendon repair.
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Affiliation(s)
- Richard H. Gelberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ryan A. Lane
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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11
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Meyer GA, Thomopoulos S, Abu-Amer Y, Shen KC. Tenotomy-induced muscle atrophy is sex-specific and independent of NFκB. eLife 2022; 11:e82016. [PMID: 36508247 PMCID: PMC9873255 DOI: 10.7554/elife.82016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The nuclear factor-κB (NFκB) pathway is a major thoroughfare for skeletal muscle atrophy and is driven by diverse stimuli. Targeted inhibition of NFκB through its canonical mediator IKKβ effectively mitigates loss of muscle mass across many conditions, from denervation to unloading to cancer. In this study, we used gain- and loss-of-function mouse models to examine the role of NFκB in muscle atrophy following rotator cuff tenotomy - a model of chronic rotator cuff tear. IKKβ was knocked down or constitutively activated in muscle-specific inducible transgenic mice to elicit a twofold gain or loss of NFκB signaling. Surprisingly, neither knockdown of IKKβ nor overexpression of caIKKβ significantly altered the loss of muscle mass following tenotomy. This finding was consistent across measures of morphological adaptation (fiber cross-sectional area, fiber length, fiber number), tissue pathology (fibrosis and fatty infiltration), and intracellular signaling (ubiquitin-proteasome, autophagy). Intriguingly, late-stage tenotomy-induced atrophy was exacerbated in male mice compared with female mice. This sex specificity was driven by ongoing decreases in fiber cross-sectional area, which paralleled the accumulation of large autophagic vesicles in male, but not female muscle. These findings suggest that tenotomy-induced atrophy is not dependent on NFκB and instead may be regulated by autophagy in a sex-specific manner.
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Affiliation(s)
- Gretchen A Meyer
- Program in Physical Therapy, Washington University School of MedicineSt. LouisUnited States
- Department of Orthopaedic Surgery, Washington University School of MedicineSt LouisUnited States
- Departments of Neurology and Biomedical Engineering, Washington University School of MedicineSt. LouisUnited States
| | - Stavros Thomopoulos
- Departments of Orthopaedic Surgery and Biomedical Engineering, Columbia UniversityNew YorkUnited States
| | - Yousef Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of MedicineSt LouisUnited States
- Department of Cell Biology & Physiology, Washington University School of MedicineSt. LouisUnited States
- Shriners Hospital for ChildrenSt. LouisUnited States
| | - Karen C Shen
- Program in Physical Therapy, Washington University School of MedicineSt. LouisUnited States
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12
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Shen H, Tarafder S, Park G, Qiu J, Xia Y, Lee CH, Gelberman RH, Thomopoulos S. The use of connective tissue growth factor mimics for flexor tendon repair. J Orthop Res 2022; 40:2754-2762. [PMID: 35212415 PMCID: PMC9402796 DOI: 10.1002/jor.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/07/2022] [Accepted: 02/13/2022] [Indexed: 02/04/2023]
Abstract
Intrasynovial flexor tendon lacerations of the hand are clinically problematic, typically requiring operative repair and extensive rehabilitation. The small-molecule connective tissue growth factor (CTGF) mimics, oxotremorine M (Oxo-M) and 4-PPBP maleate (4-PPBP), have been shown to improve tendon healing in small animal models by stimulating the expansion and differentiation of perivascular CD146+ cells. To enhance intrasynovial flexor tendon healing, small-molecule CTGF mimics were delivered to repaired canine flexor tendons via porous sutures. In vitro studies demonstrated that Oxo-M and 4-PPBP retained their bioactivity and could be released from porous sutures in a sustained manner. However, in vivo delivery of the CTGF mimics did not improve intrasynovial tendon healing. Histologic analyses and expression of tenogenic, extracellular matrix, inflammation, and remodeling genes showed similar outcomes in treated and untreated repairs across two time points. Although in vitro experiments revealed that CTGF mimics stimulated robust responses in extrasynovial tendon cells, there was no response in intrasynovial tendon cells, explaining the lack of in vivo effects. The results of the current study indicate that therapeutic strategies for tendon repair must carefully consider the environment and cellular makeup of the particular tendon for improving the healing response.
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Affiliation(s)
- Hua Shen
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | | | - Gayoung Park
- College of Dental Medicine, Columbia University, New York, NY
| | - Jichuan Qiu
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Younan Xia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Chang H. Lee
- College of Dental Medicine, Columbia University, New York, NY
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY
- Department of Biomedical Engineering, Columbia University, New York, NY
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13
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Fang F, Xiao Y, Zelzer E, Leong KW, Thomopoulos S. A mineralizing pool of Gli1-expressing progenitors builds the tendon enthesis and demonstrates therapeutic potential. Cell Stem Cell 2022; 29:1669-1684.e6. [PMID: 36459968 PMCID: PMC10422080 DOI: 10.1016/j.stem.2022.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
The enthesis, a fibrocartilaginous transition between tendon and bone, is necessary for force transfer from muscle to bone to produce joint motion. The enthesis is prone to injury due to mechanical demands, and it cannot regenerate. A better understanding of how the enthesis develops will lead to more effective therapies to prevent pathology and promote regeneration. Here, we used single-cell RNA sequencing to define the developmental transcriptome of the mouse entheses over postnatal stages. Six resident cell types, including enthesis progenitors and mineralizing chondrocytes, were identified along with their transcription factor regulons and temporal regulation. Following the prior discovery of the necessity of Gli1-lineage cells for mouse enthesis development and healing, we then examined their transcriptomes at single-cell resolution and demonstrated clonogenicity and multipotency of the Gli1-expressing progenitors. Transplantation of Gli1-lineage cells to mouse enthesis injuries improved healing, demonstrating their therapeutic potential for enthesis regeneration.
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Affiliation(s)
- Fei Fang
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA; Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yang Xiao
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA; Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA; Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA; Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA.
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14
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Forrester LA, Fang F, Jacobsen T, Hu Y, Kurtaliaj I, Roye BD, Guo XE, Chahine NO, Thomopoulos S. Transient neonatal shoulder paralysis causes early osteoarthritis in a mouse model. J Orthop Res 2022; 40:1981-1992. [PMID: 34812543 PMCID: PMC9124737 DOI: 10.1002/jor.25225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Neonatal brachial plexus palsy (NBPP) occurs in approximately 1.5 of every 1,000 live births. The majority of children with NBPP recover function of the shoulder. However, the long-term risk of osteoarthritis (OA) in this population is unknown. The purpose of this study was to investigate the development of OA in a mouse model of transient neonatal shoulder paralysis. Neonatal mice were injected twice per week for 4 weeks with saline in the right supraspinatus muscle (Saline, control) and botulinum toxin A (BtxA, transient paralysis) in the left supraspinatus muscle, and then allowed to recover for 20 or 36 weeks. Control mice received no injections, and all mice were sacrificed at 24 or 40 weeks. BtxA mice exhibited abnormalities in gait compared to controls through 10 weeks of age, but these differences did not persist into adulthood. BtxA shoulders had decreased bone volume (-9%) and abnormal trabecular microstructure compared to controls. Histomorphometry analysis demonstrated that BtxA shoulders had higher murine shoulder arthritis scale scores (+30%), and therefore more shoulder OA compared to controls. Articular cartilage of BtxA shoulders demonstrated stiffening of the tissue. Compared with controls, articular cartilage from BtxA shoulders had 2-fold and 10-fold decreases in Dkk1 and BMP2 expression, respectively, and 3-fold and 14-fold increases in Col10A1 and BGLAP expression, respectively, consistent with established models of OA. In summary, a brief period of paralysis of the neonatal mouse shoulder was sufficient to generate early signs of OA in adult cartilage and bone.
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Affiliation(s)
- Lynn Ann Forrester
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Fei Fang
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Timothy Jacobsen
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Yizhong Hu
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Iden Kurtaliaj
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Benjamin D. Roye
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - X. Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Nadeen O. Chahine
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
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15
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Huang Y, Hoppe ED, Kurtaliaj I, Birman V, Thomopoulos S, Genin GM. Effects of tendon viscoelasticity on the distribution of forces across sutures in a model tendon-to-bone repair. Int J Solids Struct 2022; 250:111725. [PMID: 38161357 PMCID: PMC10756498 DOI: 10.1016/j.ijsolstr.2022.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Tears to the rotator cuff often require surgical repair. These repairs often culminate in re-tearing when sutures break through the tendon in the weeks following repair. Although numerous studies have been performed to identify suturing strategies that reduce this risk by balancing forces across sutures, none have accounted for how the viscoelastic nature of tendon influences load sharing. With the aim of providing insight into this problem, we studied how tendon viscoelasticity, tendon stiffness, and suture anchor spacing affect this balancing of forces across sutures. Results from a model of a three-row sutured re-attachment demonstrated that optimized distributions of suture stiffnesses and of the spacing of suture anchors can balance the forces across sutures to within a few percent, even when accounting for tendon viscoelasticity. Non-optimized distributions resulted in concentrated force, typically in the outermost sutures. Results underscore the importance of accounting for viscoelastic effects in the design of tendon to bone repairs.
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Affiliation(s)
- Yuxuan Huang
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science & Technology, Rolla, Missouri, USA
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
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16
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Vinestock RC, Felsenthal N, Assaraf E, Katz E, Rubin S, Heinemann-Yerushalmi L, Krief S, Dezorella N, Levin-Zaidman S, Tsoory M, Thomopoulos S, Zelzer E. Neonatal Enthesis Healing Involves Noninflammatory Acellular Scar Formation through Extracellular Matrix Secretion by Resident Cells. Am J Pathol 2022; 192:1122-1135. [PMID: 35659946 PMCID: PMC9379688 DOI: 10.1016/j.ajpath.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Wound healing typically recruits the immune and vascular systems to restore tissue structure and function. However, injuries to the enthesis, a hypocellular and avascular tissue, often result in fibrotic scar formation and loss of mechanical properties, severely affecting musculoskeletal function and life quality. This raises questions about the healing capabilities of the enthesis. Herein, this study established an injury model to the Achilles entheses of neonatal mice to study the effectiveness of early-age enthesis healing. Histology and immunohistochemistry analyses revealed an atypical process that did not involve inflammation or angiogenesis. Instead, healing was mediated by secretion of collagen types I and II by resident cells, which formed a permanent hypocellular and avascular scar. Transmission electron microscopy showed that the cellular response to injury, including endoplasmic reticulum stress, autophagy, and cell death, varied between the tendon and cartilage ends of the enthesis. Single-molecule in situ hybridization, immunostaining, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assays verified these differences. Finally, gait analysis showed that these processes effectively restored function of the injured leg. These findings reveal a novel healing mechanism in neonatal entheses, whereby local extracellular matrix secretion by resident cells forms an acellular extracellular matrix deposit without inflammation, allowing gait restoration. These insights into the healing mechanism of a complex transitional tissue may lead to new therapeutic strategies for adult enthesis injuries.
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Affiliation(s)
- Ron C Vinestock
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Neta Felsenthal
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Assaraf
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eldad Katz
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Sarah Rubin
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | | | - Sharon Krief
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Nili Dezorella
- Department of Electron Microscopy Unit, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Levin-Zaidman
- Department of Electron Microscopy Unit, Weizmann Institute of Science, Rehovot, Israel
| | - Michael Tsoory
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot, Israel
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, New York; Department of Biomedical Engineering, Columbia University, New York, New York
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel.
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17
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Qiu J, Ahn J, Qin D, Thomopoulos S, Xia Y. Biomimetic Scaffolds with a Mineral Gradient and Funnel-Shaped Channels for Spatially Controllable Osteogenesis. Adv Healthc Mater 2022; 11:e2100828. [PMID: 34050610 DOI: 10.1002/adhm.202100828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/15/2021] [Indexed: 12/14/2022]
Abstract
A facile method is described herein for generating a mineral gradient in a biodegradable polymer scaffold. The gradient is achieved by swelling a composite film made of polycaprolactone (PCL) and hydroxyapatite (HAp) nanoparticles with a PCL solution. During the swelling process, the solvent and PCL polymer chains diffuse into the composite film, generating a gradient in HAp density at their interface. The thickness of the mineral gradient can be tuned by varying the extent of swelling to match the length scale of the natural tendon-to-bone attachment (20-60 µm). When patterned with an array of funnel-shaped channels, the mineral gradient presents stem cells with spatial gradations in both biochemical cues (e.g., osteoinductivity and conductivity associated with the HAp nanoparticles) and mechanical cues (e.g., substrate stiffness) to stimulate their differentiation into a graded distribution of cell phenotypes. This new class of biomimetic scaffolds holds great promise for facilitating the regeneration of the injured tendon-to-bone attachment by stimulating the formation of a functionally graded interface.
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Affiliation(s)
- Jichuan Qiu
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University Atlanta GA 30332 USA
| | - Jaewan Ahn
- School of Materials Science and Engineering Georgia Institute of Technology Atlanta GA 30332 USA
| | - Dong Qin
- School of Materials Science and Engineering Georgia Institute of Technology Atlanta GA 30332 USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery Department of Biomedical Engineering Columbia University New York NY 10032 USA
| | - Younan Xia
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University Atlanta GA 30332 USA
- School of Chemistry and Biochemistry School of Chemical and Biomolecular Engineering Georgia Institute of Technology Atlanta GA 30332 USA
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18
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Fang F, Linstadt RTH, Genin GM, Ahn K, Thomopoulos S. Mechanically Competent Chitosan-Based Bioadhesive for Tendon-to-Bone Repair. Adv Healthc Mater 2022; 11:e2102344. [PMID: 35026059 PMCID: PMC9117437 DOI: 10.1002/adhm.202102344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/27/2021] [Indexed: 12/13/2022]
Abstract
Current suture-based surgical techniques used to repair torn rotator cuff tendons do not result in mechanically competent tendon-to-bone attachments, leading to high postoperative failure rates. Although adhesives have been proposed to protect against sutures tearing through tendon during healing, no currently available adhesive meets the clinical needs of adhesive strength, biocompatibility, and promotion of healing. Here, a biocompatible, graded, 3,4-dihydroxy phenyl chitosan (BGC) bioadhesive designed to meet these needs is presented. Although 3,4-dihydroxy phenyl chitosan (DP-chitosan) bioadhesives are biocompatible, their adhesion strength is low; soluble oxidants or cross-linking agents can be added for higher bonding strength, but this sacrifices biocompatibility. These challenges are overcome by developing a periodate-modified ion exchange resin-bead filtration system that oxidizes catechol moieties to quinones and filters off the activating agent and resin. The resulting BGC bioadhesive exhibited sixfold higher strength compared to commercially available tissue adhesives, with strength in the range necessary to improve tendon-to-bone repair (≈1MPa, ≈20% of current suture repair strength). The bioadhesive is biocompatible and promoted tenogenesis; cells exposed to the bioadhesive demonstrated enhanced expression of collagen I and the tenogenic marker Scx. Results demonstrated that the bioadhesive has the potential to improve the strength of a tendon-to-bone repair and promote healing.
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Affiliation(s)
- Fei Fang
- Department of Orthopedic Surgery Columbia University New York NY 10032 USA
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering MechanoBiology Washington University in St. Louis St. Louis MO 63130 USA
| | - Kollbe Ahn
- ACatechol, Inc. Santa Barbara CA 93103 USA
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19
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Abraham AC, Fang F, Golman M, Oikonomou P, Thomopoulos S. The role of loading in murine models of rotator cuff disease. J Orthop Res 2022; 40:977-986. [PMID: 34081350 PMCID: PMC8639823 DOI: 10.1002/jor.25113] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/07/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff disease pathogenesis is associated with intrinsic (e.g., age, joint laxity, muscle weakness) and extrinsic (e.g., mechanical load, fatigue) factors that lead to chronic degeneration of the cuff tissues. However, etiological studies are difficult to perform in patients due to the long duration of disease onset and progression. Therefore, the purpose of this study was to determine the effects of altered joint loading on the rotator cuff. Mice were subjected to one of three load-dependent rotator cuff tendinopathy models: underuse loading, achieved by injecting botulinum toxin-A into the supraspinatus muscle; overuse loading, achieved using downhill treadmill running; destabilization loading, achieved by surgical excision of the infraspinatus tendon. All models were compared to cage activity animals. Whole joint function was assessed longitudinally using gait analysis. Tissue-scale structure and function were determined using microCT, tensile testing, and histology. The molecular response of the supraspinatus tendon and enthesis was determined by measuring the expression of 84 wound healing-associated genes. Underuse and destabilization altered forepaw weight-bearing, decreased tendon-to-bone attachment strength, decreased mineral density of the humeral epiphysis, and reduced tendon strength. Transcriptional activity of the underuse group returned to baseline levels by 4 weeks, while destabilization had significant upregulation of inflammation, growth factors, and extracellular matrix remodeling genes. Surprisingly, overuse activity caused changes in walking patterns, increased tendon stiffness, and primarily suppressed expression of wound healing-related genes. In summary, the tendinopathy models demonstrated how divergent muscle loading can result in clinically relevant alterations in rotator cuff structure, function, and gene expression.
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Affiliation(s)
- Adam C. Abraham
- University of Michigan, Department of Orthopaedic Surgery, Biomedical Science Research Building, 109 Zina Pitcher Pl, Ann Arbor, MI 48109, USA,Corresponding author Adam C. Abraham, Ph.D., Research Investigator, University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI 48109, USA,
| | - Fei Fang
- Columbia University Irving Medical Center, Department of Orthopaedic Surgery, New York, NY 10032, USA
| | - Mikhail Golman
- Columbia University, Department of Biomedical Engineering, New York, NY 10027
| | | | - Stavros Thomopoulos
- Columbia University Irving Medical Center, Department of Orthopaedic Surgery, New York, NY 10032, USA,Columbia University, Department of Biomedical Engineering, New York, NY 10027
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20
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Prabhath A, Vernekar VN, Esdaille CJ, Eisenberg E, Lebaschi A, Badon M, Seyedsalehi A, Dzidotor G, Tang X, Dyment N, Thomopoulos S, Kumbar SG, Deymier A, Weber E, Laurencin CT. Pegylated insulin-like growth factor-1 biotherapeutic delivery promotes rotator cuff regeneration in a rat model. J Biomed Mater Res A 2022; 110:1356-1371. [PMID: 35253991 DOI: 10.1002/jbm.a.37378] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 12/27/2022]
Abstract
Tears in the rotator cuff are challenging to repair because of the complex, hypocellular, hypovascular, and movement-active nature of the tendon and its enthesis. Insulin-like Growth Factor-1 (IGF-1) is a promising therapeutic for this repair. However, its unstable nature, short half-life, and ability to disrupt homeostasis has limited its clinical translation. Pegylation has been shown to improve the stability and sustain IGF-1 levels in the systemic circulation without disrupting homeostasis. To provide localized delivery of IGF-1 in the repaired tendons, we encapsulated pegylated IGF-1 mimic and its controls (unpegylated IGF-1 mimic and recombinant human IGF-1) in polycaprolactone-based matrices and evaluated them in a pre-clinical rodent model of rotator cuff repair. Pegylated-IGF-1 mimic delivery reestablished the characteristic tendon-to-bone enthesis structure and improved tendon tensile properties within 8 weeks of repair compared to controls, signifying the importance of pegylation in this complex tissue regeneration. These results demonstrate a simple and scalable biologic delivery technology alternative to tissue-derived grafts for soft tissue repair.
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Affiliation(s)
- Anupama Prabhath
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Biomedical Engineering, UConn Health, Farmington, Connecticut, USA
| | - Varadraj N Vernekar
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA
| | - Caldon J Esdaille
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA
| | - Ellen Eisenberg
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, Connecticut, USA
| | - Amir Lebaschi
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA
| | - Mary Badon
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA
| | - Amir Seyedsalehi
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Biomedical Engineering, UConn Health, Farmington, Connecticut, USA
| | - Godwin Dzidotor
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Chemical Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Xiaoyan Tang
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Material Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Nathaniel Dyment
- McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA.,Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Sangamesh G Kumbar
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Biomedical Engineering, UConn Health, Farmington, Connecticut, USA.,Department of Material Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Alix Deymier
- Department of Biomedical Engineering, UConn Health, Farmington, Connecticut, USA
| | - Eckhard Weber
- Novartis Institutes for BioMedical Research (NIBR), Basel, Switzerland
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA.,Department of Biomedical Engineering, UConn Health, Farmington, Connecticut, USA.,Department of Chemical Engineering, University of Connecticut, Storrs, Connecticut, USA.,Department of Material Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
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21
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Yang F, Das D, Karunakaran K, Genin GM, Thomopoulos S, Chasiotis I. Nonlinear time-dependent mechanical behavior of mammalian collagen fibrils. Acta Biomater 2022; 163:63-77. [PMID: 35259515 PMCID: PMC9441475 DOI: 10.1016/j.actbio.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 11/01/2022]
Abstract
The viscoelastic mechanical behavior of collagenous tissues has been studied extensively at the macroscale, yet a thorough quantitative understanding of the time-dependent mechanics of the basic building blocks of tissues, the collagen fibrils, is still missing. In order to address this knowledge gap, stress relaxation and creep tests at various stress (5-35 MPa) and strain (5-20%) levels were performed with individual collagen fibrils (average diameter of fully hydrated fibrils: 253 ± 21 nm) in phosphate buffered saline (PBS). The experimental results showed that the time-dependent mechanical behavior of fully hydrated individual collagen fibrils reconstituted from Type I calf skin collagen, is described by strain-dependent stress relaxation and stress-dependent creep functions in both the heel-toe and the linear regimes of deformation in monotonic stress-strain curves. The adaptive quasilinear viscoelastic (QLV) model, originally developed to capture the nonlinear viscoelastic response of collagenous tissues, provided a very good description of the nonlinear stress relaxation and creep behavior of the collagen fibrils. On the other hand, the nonlinear superposition (NSP) model fitted well the creep but not the stress relaxation data. The time constants and rates extracted from the adaptive QLV and the NSP models, respectively, pointed to a faster rate for stress relaxation than creep. This nonlinear viscoelastic behavior of individual collagen fibrils agrees with prior studies of macroscale collagenous tissues, thus demonstrating consistent time-dependent behavior across length scales and tissue hierarchies. STATEMENT OF SIGNIFICANCE: Pure stress relaxation and creep experiments were conducted for the first time with fully hydrated individual collagen fibrils. It is shown that collagen nanofibrils have a nonlinear time-dependent behavior which agrees with prior studies on macroscale collagenous tissues, thus demonstrating consistent time-dependent behavior across length scales and tissue hierarchies. This new insight into the non-linear viscoelastic behavior of the building blocks of mammalian collagenous tissues may serve as the foundation for improved macroscale tissue models that capture the mechanical behavior across length scales.
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22
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Golman M, Birman V, Thomopoulos S, Genin GM. Enthesis strength, toughness and stiffness: an image-based model comparing tendon insertions with varying bony attachment geometries. J R Soc Interface 2021; 18:20210421. [PMID: 34932930 PMCID: PMC8692040 DOI: 10.1098/rsif.2021.0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Tendons of the body differ dramatically in their function, mechanics and range of motion, but all connect to bone via an enthesis. Effective force transfer at the enthesis enables joint stability and mobility, with strength and stiffness arising from a fibrous architecture. However, how enthesis toughness arises across tendons with diverse loading orientations remains unclear. To study this, we performed simultaneous imaging of the bone and tendon in entheses that represent the range of tendon-to-bone insertions and extended a mathematical model to account for variations in insertion and bone geometry. We tested the hypothesis that toughness, across a range of tendon entheses, could be explained by differences observed in interactions between fibre architecture and bone architecture. In the model, toughness arose from fibre reorientation, recruitment and rupture, mediated by interactions between fibres at the enthesis and the bony ridge abutting it. When applied to tendons sometimes characterized as either energy-storing or positional, the model predicted that entheses of the former prioritize toughness over strength, while those of the latter prioritize consistent stiffness across loading directions. Results provide insight into techniques for surgical repair of tendon-to-bone attachments, and more broadly into mechanisms for the attachment of highly dissimilar materials.
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Affiliation(s)
- Mikhail Golman
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Victor Birman
- Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Stavros Thomopoulos
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Guy M. Genin
- Washington University, Jubel Hall, Room 103F, 1 Brookings Drive, St Louis, MO 63130, USA
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23
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Golman M, Abraham AC, Kurtaliaj I, Marshall BP, Hu YJ, Schwartz AG, Guo XE, Birman V, Thurner PJ, Genin GM, Thomopoulos S. Toughening mechanisms for the attachment of architectured materials: The mechanics of the tendon enthesis. Sci Adv 2021; 7:eabi5584. [PMID: 34826240 PMCID: PMC8626067 DOI: 10.1126/sciadv.abi5584] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/06/2021] [Indexed: 05/09/2023]
Abstract
Architectured materials offer tailored mechanical properties but are limited in engineering applications due to challenges in maintaining toughness across their attachments. The enthesis connects tendon and bone, two vastly different architectured materials, and exhibits toughness across a wide range of loadings. Understanding the mechanisms by which this is achieved could inform the development of engineered attachments. Integrating experiments, simulations, and previously unexplored imaging that enabled simultaneous observation of mineralized and unmineralized tissues, we identified putative mechanisms of enthesis toughening in a mouse model and then manipulated these mechanisms via in vivo control of mineralization and architecture. Imaging uncovered a fibrous architecture within the enthesis that controls trade-offs between strength and toughness. In vivo models of pathology revealed architectural adaptations that optimize these trade-offs through cross-scale mechanisms including nanoscale protein denaturation, milliscale load-sharing, and macroscale energy absorption. Results suggest strategies for optimizing architecture for tough bimaterial attachments in medicine and engineering.
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Affiliation(s)
- Mikhail Golman
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Adam C. Abraham
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Brittany P. Marshall
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Yizhong Jenny Hu
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Andrea G. Schwartz
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University, St. Louis, MO 63130, USA
| | - X. Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Victor Birman
- Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Philipp J. Thurner
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University, St. Louis, MO 63130, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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24
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Kim D, Lee B, Marshall B, Thomopoulos S, Jun YS. Cyclic strain enhances the early stage mineral nucleation and the modulus of demineralized bone matrix. Biomater Sci 2021; 9:5907-5916. [PMID: 34286730 DOI: 10.1039/d1bm00884f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The adaptive response of bones to mechanical loading is essential for musculoskeletal development. Despite the importance of collagen in bone mineralization, little is known about how cyclic strain influences physicochemical responses of collagen, especially at the early stage of mineralization when the levels of strain are higher than those in mature bones. The findings in this study show that, without any cell-mediated activity, cyclic strain increases nucleation rates of calcium phosphate (CaP) nanocrystals in highly-organized collagen matrices. The cyclic strain enhances the transport of mineralization fluids with nucleation precursors into the matrix, thus forming more CaP nanocrystals and increasing the elastic modulus of the collagen matrix. The results also suggest that the multiscale spatial distribution of nanocrystals in the fibrous collagen network determines tissue-level mechanical properties more critically than the total mineral content. By linking nano- and micro-scale observations with tissue-level mechanical properties, we provide new insights into designing better biomaterials.
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Affiliation(s)
- Doyoon Kim
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA.
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25
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Shen H, Yoneda S, Sakiyama-Elbert SE, Zhang Q, Thomopoulos S, Gelberman RH. Flexor Tendon Injury and Repair. The Influence of Synovial Environment on the Early Healing Response in a Canine Model. J Bone Joint Surg Am 2021; 103:e36. [PMID: 33475308 PMCID: PMC8192118 DOI: 10.2106/jbjs.20.01253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Environmental conditions strongly influence the healing capacity of connective tissues. Well-vascularized extrasynovial tendons typically undergo a robust wound-healing process following transection and repair. In contrast, avascular intrasynovial tendons do not mount an effective repair response. The current study tests the hypothesis that flexor tendons, as a function of their synovial environment, exhibit unique inflammatory, angiogenic, and metabolic responses to injury and repair. METHODS Flexor tendons present a distinct opportunity to test the study hypothesis, as they have proximal regions that are extrasynovial and distal regions that are intrasynovial. In an internally controlled study design, the second and fifth forepaw flexor tendons were transected and repaired in either the extrasynovial or the intrasynovial anatomical region. Histological, gene expression, and proteomics analyses were performed at 3 and 7 days to define the early biological events that drive synovial environment-dependent healing responses. RESULTS Uninjured intrasynovial tendons were avascular, contained high levels of proteoglycans, and expressed inflammatory factors, complement proteins, and glycolytic enzymes. In contrast, extrasynovial tendons were well vascularized, contained low levels of proteoglycans, and were enriched in inflammation inhibitors and oxidative phosphorylation enzymes. The response to injury and repair was markedly different between the 2 tendon regions. Extrasynovial tendons displayed a robust and rapid neovascularization response, increased expression levels of complement proteins, and an acute shift in metabolism to glycolysis, whereas intrasynovial tendons showed minimal vascularity and muted inflammatory and metabolic responses. CONCLUSIONS The regional molecular profiles of intact and healing flexor tendons revealed extensive early differences in innate immune response, metabolism, vascularization, and expression of extracellular matrix as a function of the synovial environment. These differences reveal mechanisms through which extrasynovial tendons heal more effectively than do intrasynovial tendons. CLINICAL RELEVANCE To improve outcomes after operative repair, future treatment strategies should promote features of extrasynovial healing, such as enhanced vascularization and modulation of the complement system and/or glucose metabolism.
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Affiliation(s)
- Hua Shen
- Washington University in St. Louis, St. Louis, Missouri
| | - Susumu Yoneda
- Washington University in St. Louis, St. Louis, Missouri
- University of the Ryukyus, Okinawa, Japan
| | | | - Qiang Zhang
- Washington University in St. Louis, St. Louis, Missouri
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Abstract
Tendon-to-bone repair often fails because the functionally graded attachment is not regenerated during the healing process. Biomimetic scaffolds that recapitulate the unique features of the native tendon-to-bone attachment hold great promise for enhancing the healing process. Among various types of scaffolds that are developed and evaluated for tendon-to-bone repair, those with gradations (in either a stratified or a continuous fashion) in composition, structure, mechanical properties, and cell phenotype have gained the most attention. In this progress report, the recent efforts in the rational design and fabrication of functionally graded scaffolds based upon electrospun nanofiber mats and inverse opal structures, as well as the evaluation of their applications in augmenting tendon-to-bone repair, are reviewed. This report concludes with perspectives on the necessary future steps for clinical translation of the scaffolds.
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Affiliation(s)
- Chunlei Zhu
- Key Laboratory of Functional Polymer Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, Institute of Polymer Chemistry, College of Chemistry, Nankai University, Tianjin, 300071, China
| | - Jichuan Qiu
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Younan Xia
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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27
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Marshall B, Loya A, Drazan J, Prato A, Conley N, Thomopoulos S, E Reuther K. Developing a STEM+M Identity in Underrepresented Minority Youth Through Biomechanics and Sports-Based Education. J Biomech Eng 2021; 143:1084702. [PMID: 32568379 DOI: 10.1115/1.4047548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Indexed: 11/08/2022]
Abstract
A Science, Technology, Engineering, Math, and Medicine (STEM+M) identity, a form of social identity, is the extent to which an individual feels accepted in the STEM+M career fields. The development of a strong STEM+M identity hinges largely on one's perceived self-efficacy in STEM+M and can be bolstered by associating STEM+M with other areas in which an individual already exhibits self-efficacy. In this study, a basketball camp served as a platform for STEM+M education in an effort to link participants' self-efficacy in basketball to STEM+M concepts where they may feel less self-efficacious. Over the first 2 years of the program, known as the Youth Sports Lab (YSL), two cohorts of underrepresented minority (URM) middle school students attended a 4-day long basketball camp hosted at Columbia University in partnership with Harlem- and Albany-based afterschool programs. The camp consisted of basketball training, jump plate fabrication, data collection, invited speakers, and group-based research projects. Our hypotheses were that participation in the program would lead to improved (1) familiarity, (2) perceived importance, and (3) interest in STEM+M. Participant responses, gathered from a 17-question Likert-scale survey administered before and after the camp, demonstrated 10 questions with significantly increased responses due to the program. The results support the conclusion that the sports-based engineering program increased STEM+M identity in the URM cohort. Future improvements to the program will include midyear student engagement and long-term follow-up.
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Affiliation(s)
- Brittany Marshall
- Carroll Laboratories for Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650 W 168th Street, New York, NY 10032
| | - Amy Loya
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 1623 15th Street, 2113, Troy, NY 12180
| | - John Drazan
- Human Motion Lab Penn Medicine, University of Pennsylvania, 3737 Market Street, Suite 702, Philadelphia, PA 19104
| | - Anthony Prato
- Department of Psychology, State University of New York, College at Geneseo, 1 College Circle, Geneseo, NY 14454
| | - Nicole Conley
- Department of Biomedical Engineering, University of Connecticut, 2075 Hillside Road, Storrs, CT 06269
| | - Stavros Thomopoulos
- Carroll Laboratories for Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650 W 168th Street, New York, NY 10032
| | - Katherine E Reuther
- Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, New York, NY 10027
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28
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Abstract
BACKGROUND More than 450,000 rotator cuff repairs are performed annually, yet healing of tendon to bone often fails. This failure is rooted in the fibrovascular healing response, which does not regenerate the native attachment site. Better healing outcomes may be achieved by targeting inflammation during the early period after repair. Rather than broad inhibition of inflammation, which may impair healing, the current study utilized a molecularly targeted approach to suppress IKKβ, shutting down only the inflammatory arm of the nuclear factor κB (NF-κB) signaling pathway. PURPOSE To evaluate the therapeutic potential of IKKβ inhibition in a clinically relevant model of rat rotator cuff repair. STUDY DESIGN Controlled laboratory study. METHODS After validating the efficacy of the IKKβ inhibitor in vitro, it was administered orally once a day for 7 days after surgery in a rat rotator cuff repair model. The effect of treatment on reducing inflammation and improving repair quality was evaluated after 3 days and 2, 4, and 8 weeks of healing, using gene expression, biomechanics, bone morphometry, and histology. RESULTS Inhibition of IKKβ attenuated cytokine and chemokine production in vitro, demonstrating the potential for this inhibitor to reduce inflammation in vivo. Oral treatment with IKKβ inhibitor reduced NF-κB target gene expression by up to 80% compared with a nontreated group at day 3, with a subset of these genes suppressed through 14 days. Furthermore, the IKKβ inhibitor led to enhanced tenogenesis and extracellular matrix production, as demonstrated by gene expression and histological analyses. At 4 weeks, inhibitor treatment led to increased toughness, no effects on failure load and strength, and decreases in stiffness and modulus when compared with vehicle control. At 8 weeks, IKKβ inhibitor treatment led to increased toughness, failure load, and strength compared with control animals. IKKβ inhibitor treatment prevented the bone loss near the tendon attachment that occurred in repairs in control. CONCLUSION Pharmacological inhibition of IKKβ successfully suppressed excessive inflammation and enhanced tendon-to-bone healing after rotator cuff repair in a rat model. CLINICAL RELEVANCE The NF-κB pathway is a promising target for enhancing outcomes after rotator cuff repair.
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Affiliation(s)
- Mikhail Golman
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Xiaoning Li
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Dimitrios Skouteris
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Adam A. Abraham
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Lee Song
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Yousef Abu-Amer
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Stavros Thomopoulos
- Department of Biomedical Engineering, Columbia University, New York, New York, USA.,Department of Orthopedic Surgery, Columbia University, New York, New York, USA.,Address correspondence to Stavros Thomopoulos, PhD, Carroll Laboratories of Orthopedic Research, Columbia University, Black Building, Room 1408, 650 W 168 St, New York, NY 10032-3702, USA () (Twitter: @ThomopoulosLab)
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29
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Fang F, Schwartz AG, Moore ER, Sup ME, Thomopoulos S. Primary cilia as the nexus of biophysical and hedgehog signaling at the tendon enthesis. Sci Adv 2020; 6:6/44/eabc1799. [PMID: 33127677 PMCID: PMC7608799 DOI: 10.1126/sciadv.abc1799] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/17/2020] [Indexed: 05/10/2023]
Abstract
The tendon enthesis is a fibrocartilaginous tissue critical for transfer of muscle forces to bone. Enthesis pathologies are common, and surgical repair of tendon to bone is plagued by high failure rates. At the root of these failures is a gap in knowledge of how the tendon enthesis is formed and maintained. We tested the hypothesis that the primary cilium is a hub for transducing biophysical and hedgehog (Hh) signals to regulate tendon enthesis formation and adaptation to loading. Primary cilia were necessary for enthesis development, and cilia assembly was coincident with Hh signaling and enthesis mineralization. Cilia responded inversely to loading; increased loading led to decreased cilia and decreased loading led to increased cilia. Enthesis responses to loading were dependent on Hh signaling through cilia. Results imply a role for tendon enthesis primary cilia as mechanical responders and Hh signal transducers, providing a therapeutic target for tendon enthesis pathologies.
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Affiliation(s)
- Fei Fang
- Department of Orthopedic Surgery, Columbia University, New York, NY, 10032, USA
| | - Andrea G Schwartz
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Emily R Moore
- School of Dental Medicine, Harvard University, Cambridge, MA, 02138, USA
| | - McKenzie E Sup
- Department of Orthopedic Surgery, Columbia University, New York, NY, 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, 10032, USA.
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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30
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Shen H, Schwartz AG, Civitelli R, Thomopoulos S. Connexin 43 Is Necessary for Murine Tendon Enthesis Formation and Response to Loading. J Bone Miner Res 2020; 35:1494-1503. [PMID: 32227614 PMCID: PMC7725385 DOI: 10.1002/jbmr.4018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/08/2020] [Accepted: 03/21/2020] [Indexed: 12/28/2022]
Abstract
The enthesis is a mineralized fibrocartilage transition that attaches tendon to bone and is vital for musculoskeletal function. Despite recent studies demonstrating the necessity of muscle loading for enthesis formation, the mechanisms that regulate enthesis formation and mechanoresponsiveness remain unclear. Therefore, the current study investigated the role of the gap junction protein connexin 43 in these processes by deleting Gja1 (the Cx43 gene) in the tendon and enthesis. Compared with their wild-type (WT) counterparts, mice lacking Cx43 showed disrupted entheseal cell alignment, reduced mineralized fibrocartilage, and impaired biomechanical properties of the supraspinatus tendon entheses during postnatal development. Cx43-deficient mice also exhibited reduced ability to complete a treadmill running protocol but no apparent deficits in daily activity, metabolic indexes, shoulder muscle size, grip strength, and major trabecular bone properties of the adjacent humeral head. To examine enthesis mechanoresponsiveness, young adult mice were subjected to modest treadmill exercise. Gja1 deficiency in the tendon and enthesis reduced entheseal anabolic responses to treadmill exercise: WT mice had increased expression of Sox9, Ihh, and Gli1 and increased Brdu incorporation, whereas Cx43-deficient mice showed no changes or decreased levels with exercise. Collectively, the results demonstrated an essential role for Cx43 in postnatal tendon enthesis formation, function, and response to loading; results further provided evidence implicating a link between Cx43 function and the hedgehog signaling pathway. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Hua Shen
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Andrea G Schwartz
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Roberto Civitelli
- Department of Internal Medicine, Division of Bone and Mineral Disease, Washington University, St. Louis, MO, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
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31
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Boyle JJ, Pless RB, Thomopoulos S, Genin GM. Direct Estimation of Surface Strain Fields From a Stereo Vision System. J Biomech Eng 2020; 142:1072293. [PMID: 31891380 DOI: 10.1115/1.4045813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 11/08/2022]
Abstract
Estimating strain on surfaces of deforming three-dimensional (3D) structures is a critical need in experimental mechanics. Although single-camera techniques excel at estimating deformation on a surface parallel to the imaging plane, they are prone to artifact for 3D motion because they cannot distinguish between out-of-plane motion and in-plane dilatation. Multiview (e.g., stereo) camera systems overcome this via a three-step process consisting of: (1) independent surface registration, (2) triangulation to estimate surface displacements, and (3) deformation estimation. However, existing methods are prone to errors associated with numerical differentiation when computing estimating strain fields from displacement fields unless regularization schemes are used. Such regularization schemes can introduce inaccuracy into strain estimation. Inspired by previous work which combined registration and deformation estimation into a single step for 2D images and 3D imaging stacks, we developed a theory for simultaneous image registration, 3D triangulation, and deformation estimation in a multiview system. The deformation estimation does not require numerical differentiation of displacement fields to estimate strain fields. We present here the theoretical foundations and derivation of two related implementations of this approach, and discuss their strengths and weaknesses.
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Affiliation(s)
- John J Boyle
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032-3702; Department of Biomedical Engineering, Washington University, St Louis, MO 63130
| | - Robert B Pless
- Department of Computer Science, George Washington University, Washington, DC 20052
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032; Department of Biomedical Engineering, Columbia University, New York, NY 10032
| | - Guy M Genin
- Department of Mechanical Engineering and Materials Science, NSF Science and Technology Center for Engineering MechanoBiology, Washington University, St Louis, MO 63130
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32
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Avgoulas EI, Sutcliffe MPF, Linderman SW, Birman V, Thomopoulos S, Genin GM. Adhesive-based tendon-to-bone repair: failure modelling and materials selection. J R Soc Interface 2020; 16:20180838. [PMID: 30966948 DOI: 10.1098/rsif.2018.0838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Surgical reattachment of tendon to bone is a procedure marked by high failure rates. For example, nearly all rotator cuff repairs performed on elderly patients with massive tears ultimately result in recurrence of tearing. These high failure rates have been attributed to stress concentrations that arise due to the mechanical mismatch between tendon and bone. Although recent studies have identified potential adhesives with mechanical properties tuned to alleviate these stress concentrations, and thereby delay the onset of failure, resistance to the progression of failure has not been studied. Here, we refined the space of adhesive material properties that can improve surgical attachment by considering the fracture process. Using cohesive zone modelling and physiologically relevant values of mode I and mode II adhesive fracture toughnesses, we predicted the maximum displacement and strength at failure of idealized, adhesively bonded tendon-to-bone repairs. Repair failure occurred due to excessive relative displacement of the tendon and bone tissues for strong and compliant adhesives. The failure mechanism shifted to rupture of the entire repair for stiffer adhesives below a critical shear strength. Results identified a narrow range of materials on an Ashby chart that are suitable for adhesive repair of tendon to bone, including a range of elastomers and porous solids.
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Affiliation(s)
- Evangelos I Avgoulas
- 1 Department of Engineering, University of Cambridge , Trumpington Street, Cambridge CB2 1PZ , UK
| | - Michael P F Sutcliffe
- 1 Department of Engineering, University of Cambridge , Trumpington Street, Cambridge CB2 1PZ , UK
| | - Stephen W Linderman
- 2 Department of Orthopaedic Surgery, Washington University School of Medicine , St Louis, MO 63131 , USA
| | - Victor Birman
- 3 Missouri Science and Technology Global-St Louis, and Department of Mechanical and Aerospace Engineering , St Louis, MO 63131 , USA
| | - Stavros Thomopoulos
- 4 Department of Orthopedic Surgery, Columbia University , New York, NY 10032 , USA.,5 Department of Biomedical Engineering, Columbia University , New York, NY 10032 , USA
| | - Guy M Genin
- 6 NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical and Aerospace Engineering, Washington University , St Louis, MO 63130 , USA
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33
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Liu Y, Schwartz AG, Hong Y, Peng X, Xu F, Thomopoulos S, Genin GM. Correction of bias in the estimation of cell volume fraction from histology sections. J Biomech 2020; 104:109705. [PMID: 32247525 DOI: 10.1016/j.jbiomech.2020.109705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/10/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Accurate determination of the fraction of a tissue's volume occupied by cells is critical for studying tissue development, pathology, and biomechanics. For example, homogenization methods that predict the function and responses of tissues based upon the properties of the tissue's constituents require estimates of cell volume fractions. A common way to estimate cellular volume fraction is to image cells in thin, planar histologic sections, and then invoke either the Delesse or the Glagolev principle to estimate the volume fraction from the measured area fraction. The Delesse principle relies upon the observation that for randomly aligned, identical features, the expected value of the observed area fraction of a phase equals the volume fraction of that phase, and the Glagolev principle relies on a similar observation for random rather than planar sampling. These methods are rigorous for analysis of a polished, opaque rock sections and for histologic sections that are thin compared to the characteristic length scale of the cells. However, when histologic slices cannot be cut sufficiently thin, a bias will be introduced. Although this bias - known as the Holmes effect in petrography - has been resolved for opaque spheres in a transparent matrix, it has not been addressed for histologic sections presenting the opposite problem, namely transparent cells in an opaque matrix. In this note, we present a scheme for correcting the bias in volume fraction estimates for transparent components in a relatively opaque matrix.
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Affiliation(s)
- Yanxin Liu
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, United States
| | - Andrea G Schwartz
- Department of Orthopaedic Surgery, Washington University School of Medicine, United States
| | - Yuan Hong
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, United States; NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, United States; Bioinspired Engineering and Biomechanics Center, School of Life Sciences and Technology, Xi'an Jiaotong University, China
| | - Xiangjun Peng
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, United States; NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, United States; Bioinspired Engineering and Biomechanics Center, School of Life Sciences and Technology, Xi'an Jiaotong University, China
| | - Feng Xu
- Bioinspired Engineering and Biomechanics Center, School of Life Sciences and Technology, Xi'an Jiaotong University, China
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, United States
| | - Guy M Genin
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, United States; NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, United States; Bioinspired Engineering and Biomechanics Center, School of Life Sciences and Technology, Xi'an Jiaotong University, China.
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34
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O'Keefe RJ, Tuan RS, Lane NE, Awad HA, Barry F, Bunnell BA, Colnot C, Drake MT, Drissi H, Dyment NA, Fortier LA, Guldberg RE, Kandel R, Little DG, Marshall MF, Mao JJ, Nakamura N, Proffen BL, Rodeo SA, Rosen V, Thomopoulos S, Schwarz EM, Serra R. American Society for Bone and Mineral Research-Orthopaedic Research Society Joint Task Force Report on Cell-Based Therapies - Secondary Publication. J Orthop Res 2020; 38:485-502. [PMID: 31994782 DOI: 10.1002/jor.24485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
Cell-based therapies, defined here as the delivery of cells in vivo to treat disease, have recently gained increasing public attention as a potentially promising approach to restore structure and function to musculoskeletal tissues. Although cell-based therapy has the potential to improve the treatment of disorders of the musculoskeletal system, there is also the possibility of misuse and misrepresentation of the efficacy of such treatments. The medical literature contains anecdotal reports and research studies, along with web-based marketing and patient testimonials supporting cell-based therapy. Both the American Society for Bone and Mineral Research (ASBMR) and the Orthopaedic Research Society (ORS) are committed to ensuring that the potential of cell-based therapies is realized through rigorous, reproducible, and clinically meaningful scientific discovery. The two organizations convened a multidisciplinary and international Task Force composed of physicians, surgeons, and scientists who are recognized experts in the development and use of cell-based therapies. The Task Force was charged with defining the state-of-the art in cell-based therapies and identifying the gaps in knowledge and methodologies that should guide the research agenda. The efforts of this Task Force are designed to provide researchers and clinicians with a better understanding of the current state of the science and research needed to advance the study and use of cell-based therapies for skeletal tissues. The design and implementation of rigorous, thorough protocols will be critical to leveraging these innovative treatments and optimizing clinical and functional patient outcomes. In addition to providing specific recommendations and ethical considerations for preclinical and clinical investigations, this report concludes with an outline to address knowledge gaps in how to determine the cell autonomous and nonautonomous effects of a donor population used for bone regeneration. © 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:485-502, 2020.
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Affiliation(s)
- Regis J O'Keefe
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Rocky S Tuan
- The Chinese University of Hong Kong, Institute for Tissue Engineering and Regenerative Medicine, Hong Kong SAR, China
| | - Nancy E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - Hani A Awad
- Department of Biomedical Engineering, Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Frank Barry
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
| | - Bruce A Bunnell
- Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | | | - Matthew T Drake
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory Healthcare, Emory University, Tucker, GA, USA
| | - Nathaniel A Dyment
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Fortier
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Robert E Guldberg
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Rita Kandel
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - David G Little
- Orthopaedic Research and Biotechnology, Kids Research Institute, Westmead, Australia
| | - Mary F Marshall
- Center for Biomedical Ethics and Humanities, University of Virginia, Charlottesville, VA, USA
| | - Jeremy J Mao
- Division of Orthodontics, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Benedikt L Proffen
- Department of Orthopaedic Surgery, Sports Medicine Research Laboratory, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | | | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Rosa Serra
- University of Alabama at Birmingham, AL, USA
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35
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Abraham AC, Shah SA, Golman M, Song L, Li X, Kurtaliaj I, Akbar M, Millar NL, Abu-Amer Y, Galatz LM, Thomopoulos S. Targeting the NF-κB signaling pathway in chronic tendon disease. Sci Transl Med 2020; 11:11/481/eaav4319. [PMID: 30814338 DOI: 10.1126/scitranslmed.aav4319] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
Abstract
Tendon disorders represent the most common musculoskeletal complaint for which patients seek medical attention; inflammation drives tendon degeneration before tearing and impairs healing after repair. Clinical evidence has implicated the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway as a correlate of pain-free return to function after surgical repair. However, it is currently unknown whether this response is a reaction to or a driver of pathology. Therefore, we aimed to understand the clinically relevant involvement of the NF-κB pathway in tendinopathy, to determine its potential causative roles in tendon degeneration, and to test its potential as a therapeutic candidate. Transcriptional profiling of early rotator cuff tendinopathy identified increases in NF-κB signaling, including increased expression of the regulatory serine kinase subunit IKKβ, which plays an essential role in inflammation. Using cre-mediated overexpression of IKKβ in tendon fibroblasts, we observed degeneration of mouse rotator cuff tendons and the adjacent humeral head. These changes were associated with increases in proinflammatory cytokines and innate immune cells within the joint. Conversely, genetic deletion of IKKβ in tendon fibroblasts partially protected mice from chronic overuse-induced tendinopathy. Furthermore, conditional knockout of IKKβ improved outcomes after surgical repair, whereas overexpression impaired tendon healing. Accordingly, targeting of the IKKβ/NF-κB pathway in tendon stromal cells may offer previously unidentified therapeutic approaches in the management of human tendon disorders.
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Affiliation(s)
- Adam C Abraham
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Shivam A Shah
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Mikhail Golman
- Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
| | - Lee Song
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Xiaoning Li
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Iden Kurtaliaj
- Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
| | - Moeed Akbar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Ave., Glasgow, Scotland G12 8TA, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Ave., Glasgow, Scotland G12 8TA, UK
| | - Yousef Abu-Amer
- Departments of Orthopedic Surgery and Cell Biology and Physiology, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA.,Shriners Hospital for Children, 4400 Clayton Ave, St. Louis, MO 63110, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Mount Sinai, 5 E 98th St., New York, NY 10029, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA. .,Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
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36
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Deymier AC, Schwartz AG, Lim C, Wingender B, Kotiya A, Shen H, Silva MJ, Thomopoulos S. Multiscale effects of spaceflight on murine tendon and bone. Bone 2020; 131:115152. [PMID: 31730829 PMCID: PMC7138367 DOI: 10.1016/j.bone.2019.115152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 12/22/2022]
Abstract
Despite a wealth of data on the effects of spaceflight on tendons and bones, little is known about its effects on the interfacial tissue between these two structures, the enthesis. Mice were sent to space on three separate missions: STS-131, STS-135, and Bion-M1 to determine how spaceflight affects the composition, structure, mechanics, and gene expression of the humerus-supraspinatus and calcaneus-Achilles entheses. At the nanoscale, spaceflight resulted in decreased carbonate levels in the bone, likely due to increased remodeling, as suggested by increased expression of genes related to osteoclastogenesis (CatK, Tnfsf11) and mature osteoblasts (Col1, Osc). Tendons showed a shift in collagen fibril size towards smaller diameters that may have resulted from increased expression of genes related to collagen degradation (Mmp3, Mmp13). These nanoscale changes did not result in micro- and milliscale changes to the structure and mechanics of the enthesis. There were no changes in bone volume, trabecular structure, failure load, or stiffness with spaceflight. This lack of tissue-level change may be anatomy based, as extremities may be less sensitive to spaceflight than central locations such as vertebrae, yet results highlight that the tendon enthesis may be robust against negative effects of spaceflight.
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Affiliation(s)
- Alix C Deymier
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, United States of America.
| | - Andrea G Schwartz
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States of America
| | - Chanteak Lim
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States of America
| | - Brian Wingender
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, United States of America
| | - Akhilesh Kotiya
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States of America
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States of America
| | - Matthew J Silva
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States of America
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, United States of America; Department of Biomedical Engineering, Columbia University, New York, NY, United States of America.
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37
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Golman M, Wright ML, Wong TT, Lynch TS, Ahmad CS, Thomopoulos S, Popkin CA. Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System. Am J Sports Med 2020; 48:359-369. [PMID: 31913662 DOI: 10.1177/0363546519894333] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. PURPOSE To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)-based classification system for partial patellar tendon injuries. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. RESULTS Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without (P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. CONCLUSION Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.
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Affiliation(s)
- Mikhail Golman
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA.,Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Margaret L Wright
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA
| | - Tony T Wong
- Department of Musculoskeletal Radiology, Columbia University Medical Center, New York, New York, USA
| | - T Sean Lynch
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA
| | - Christopher S Ahmad
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA.,Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, New York, USA
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38
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Affiliation(s)
- Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY.,Department of Biomedical Engineering, Columbia University, New York, NY
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39
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O'Keefe RJ, Tuan RS, Lane NE, Awad HA, Barry F, Bunnell BA, Colnot C, Drake MT, Drissi H, Dyment NA, Fortier LA, Guldberg RE, Kandel R, Little DG, Marshall MF, Mao JJ, Nakamura N, Proffen BL, Rodeo SA, Rosen V, Thomopoulos S, Schwarz EM, Serra R. American Society for Bone and Mineral Research-Orthopaedic Research Society Joint Task Force Report on Cell-Based Therapies. J Bone Miner Res 2020; 35:3-17. [PMID: 31545883 DOI: 10.1002/jbmr.3839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/28/2019] [Accepted: 06/13/2019] [Indexed: 01/01/2023]
Abstract
Cell-based therapies, defined here as the delivery of cells in vivo to treat disease, have recently gained increasing public attention as a potentially promising approach to restore structure and function to musculoskeletal tissues. Although cell-based therapy has the potential to improve the treatment of disorders of the musculoskeletal system, there is also the possibility of misuse and misrepresentation of the efficacy of such treatments. The medical literature contains anecdotal reports and research studies, along with web-based marketing and patient testimonials supporting cell-based therapy. Both the American Society for Bone and Mineral Research (ASBMR) and the Orthopaedic Research Society (ORS) are committed to ensuring that the potential of cell-based therapies is realized through rigorous, reproducible, and clinically meaningful scientific discovery. The two organizations convened a multidisciplinary and international Task Force composed of physicians, surgeons, and scientists who are recognized experts in the development and use of cell-based therapies. The Task Force was charged with defining the state-of-the art in cell-based therapies and identifying the gaps in knowledge and methodologies that should guide the research agenda. The efforts of this Task Force are designed to provide researchers and clinicians with a better understanding of the current state of the science and research needed to advance the study and use of cell-based therapies for skeletal tissues. The design and implementation of rigorous, thorough protocols will be critical to leveraging these innovative treatments and optimizing clinical and functional patient outcomes. In addition to providing specific recommendations and ethical considerations for preclinical and clinical investigations, this report concludes with an outline to address knowledge gaps in how to determine the cell autonomous and nonautonomous effects of a donor population used for bone regeneration. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Regis J O'Keefe
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Rocky S Tuan
- The Chinese University of Hong Kong, Institute for Tissue Engineering and Regenerative Medicine, Hong Kong SAR, China
| | - Nancy E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - Hani A Awad
- Department of Biomedical Engineering, Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Frank Barry
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
| | - Bruce A Bunnell
- Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | | | - Matthew T Drake
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory Healthcare, Emory University, Tucker, GA, USA
| | - Nathaniel A Dyment
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Fortier
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Robert E Guldberg
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Rita Kandel
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - David G Little
- Orthopaedic Research and Biotechnology, Kids Research Institute, Westmead, Australia
| | - Mary F Marshall
- Center for Biomedical Ethics and Humanities, University of Virginia, Charlottesville, VA, USA
| | - Jeremy J Mao
- Division of Orthodontics, College of Dental Medicine, Columbia University, New York, NY, USA
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Benedikt L Proffen
- Department of Orthopaedic Surgery, Sports Medicine Research Laboratory, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | | | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Rosa Serra
- University of Alabama at Birmingham, AL, USA
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40
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Kim D, Lee B, Marshall BP, Jang E, Thomopoulos S, Jun YS. Pulsed Electrical Stimulation Enhances Body Fluid Transport for Collagen Biomineralization. ACS Appl Bio Mater 2019; 3:902-910. [DOI: 10.1021/acsabm.9b00979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Doyoon Kim
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Byeongdu Lee
- X-ray Science Division, Argonne National Laboratory, Argonne, Illinois 60439, United States
| | - Brittany P. Marshall
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York 10032-3072, United States
| | - Eunyoung Jang
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York 10032-3072, United States
| | - Young-Shin Jun
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
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41
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Tarafder S, Brito JA, Minhas S, Effiong L, Thomopoulos S, Lee CH. In situ tissue engineering of the tendon-to-bone interface by endogenous stem/progenitor cells. Biofabrication 2019; 12:015008. [PMID: 31561236 PMCID: PMC6904927 DOI: 10.1088/1758-5090/ab48ca] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The long-term success of surgical repair of rotator cuff tears is largely dependent on restoration of a functional tendon-to-bone interface. We implemented micro-precise spatiotemporal delivery of growth factors in three-dimensional printed scaffolds for integrative regeneration of a fibrocartilaginous tendon-to-bone interface. Sustained and spatially controlled release of tenogenic, chondrogenic and osteogenic growth factors was achieved using microsphere-based delivery carriers embedded in thin membrane-like scaffolds. In vitro, the scaffolds embedded with spatiotemporal delivery of growth factors successfully guided regional differentiation of mesenchymal progenitor cells, forming multiphase tissues with tendon-like, cartilage-like and bone-like regions. In vivo, when implanted at the interface between the supraspinatus tendon and the humeral head in a rat rotator cuff repair model, these scaffolds promoted recruitment of endogenous tendon progenitor cells followed by integrative healing of tendon and bone via re-formation of strong fibrocartilaginous interfaces. Our findings demonstrate the potential of in situ tissue engineering of tendon-to-bone interfaces by endogenous progenitor cells. The in situ tissue engineering approach shows translational potential for improving outcomes after rotator cuff repair.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - John A Brito
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - Sumeet Minhas
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - Linda Effiong
- Department of Orthopedic Surgery, Columbia University Medical Center, 650 W. 168th Street, BB14-1408, NY 10032, New York
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University Medical Center, 650 W. 168th Street, BB14-1408, NY 10032, New York
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, NY 10027, New York
| | - Chang H Lee
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
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Abstract
Tendon disorders are common, affect people of all ages, and are often debilitating. Standard treatments, such as anti-inflammatory drugs, rehabilitation, and surgical repair, often fail. In order to define tendon function and demonstrate efficacy of new treatments, the mechanical properties of tendons from animal models must be accurately determined. Murine animal models are now widely used to study tendon disorders and evaluate novel treatments for tendinopathies; however, determining the mechanical properties of mouse tendons has been challenging. In this study, a new system was developed for tendon mechanical testing that includes 3D-printed fixtures that exactly match the anatomies of the humerus and calcaneus to mechanically test supraspinatus tendons and Achilles tendons, respectively. These fixtures were developed using 3D reconstructions of native bone anatomy, solid modeling, and additive manufacturing. The new approach eliminated artifactual gripping failures (e.g., failure at the growth plate failure rather than in the tendon), decreased overall testing time, and increased reproducibility. Furthermore, this new method is readily adaptable for testing other murine tendons and tendons from other animals.
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Affiliation(s)
- Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University; Department of Biomedical Engineering, Columbia University
| | - Mikhail Golman
- Department of Orthopedic Surgery, Columbia University; Department of Biomedical Engineering, Columbia University
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University; Department of Biomedical Engineering, Columbia University;
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43
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Li X, Pongkitwitoon S, Lu H, Lee C, Gelberman R, Thomopoulos S. CTGF induces tenogenic differentiation and proliferation of adipose-derived stromal cells. J Orthop Res 2019; 37:574-582. [PMID: 30756417 PMCID: PMC6467286 DOI: 10.1002/jor.24248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
Intrasynovial tendons are paucicellular and hypovascular, resulting in a poor response to injury. Surgical repair of ruptured or lacerated tendons often lead to complications such as adhesions, repair site gapping, and repair site rupture. Adipose-derived stem cells (ASCs) have shown promise for enhancing tendon repair, as they have the capacity to differentiate into tendon fibroblasts and augment the healing response. Furthermore, connective tissue growth factor (CTGF) has been shown to promote tendon regeneration via the stimulation of endogenous tendon stem cells. Here, we evaluated the potential of CTGF to promote tenogenic differentiation of ASCs in vitro. Gene and protein expression, cell proliferation, and FAK and ERK1/2 signaling were assessed. CTGF increased tenogenic genes in mouse ASCs in a dose- and time-dependent manner. Western blot and immunostaining analyses demonstrated increases in tenogenic protein expression in CTGF-treated ASCs at all timepoints studied. CTGF increased ASC proliferation in a dose-dependent manner. CTGF induced phosphorylation of ERK1/2 within 5 min and FAK within 15 min; both signals persisted for 120 min. Blocking FAK and ERK1/2 pathways by selective inhibitors SCH772984 and PF573228, respectively, attenuated the CTGF-induced tenogenic differentiation and proliferation of ASCs. These results suggest that CTGF induces tenogenic differentiation of ASCs via the FAK and ERK1/2 pathway. Statement of clinical significance: Although prior research has led to advances in tendon operative techniques and rehabilitation methods, clinical outcomes after tendon repair remain variable, with high rates of repair site gapping or rupture. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Xiaoning Li
- Xiangya Hospital, Central South University, Changsha, PR China,Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
| | - Suphannee Pongkitwitoon
- Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
| | - Hongbin Lu
- Xiangya Hospital, Central South University, Changsha, PR China
| | - Chang Lee
- College of Dental Medicine, Columbia University, New York, New York
| | - Richard Gelberman
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
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44
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Deymier AC, Schwartz AG, Cai Z, Daulton TL, Pasteris JD, Genin GM, Thomopoulos S. The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis. Acta Biomater 2019; 83:302-313. [PMID: 30342287 DOI: 10.1016/j.actbio.2018.10.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Abstract
The musculoskeletal system is sensitive to its loading environment; this is of particular concern under conditions such as disuse, paralysis, and extended-duration space flight. Although structural and mechanical changes to tendon and bone following paralysis and disuse are well understood, there is a pressing need to understand how this unloading affects the bone-tendon interface (enthesis); the location most prone to tears and injury. We therefore elucidated these effects of unloading in the entheses of adult mice shoulders that were paralyzed for 21 days by treatment with botulinum toxin A. Unloading significantly increased the extent of mechanical failure and was associated with structural changes across hierarchical scales. At the millimeter scale, unloading caused bone loss. At the micrometer scale, unloading decreased bioapatite crystal size and crystallographic alignment in the enthesis. At the nanometer scale, unloading induced compositional changes that stiffened the bioapatite/collagen composite tissue. Mathematical modeling and mechanical testing indicated that these factors combined to increase local elevations of stress while decreasing the ability of the tissue to absorb energy prior to failure, thereby increasing injury risk. These first observations of the multiscale effects of unloading on the adult enthesis provide new insight into the hierarchical features of structure and composition that endow the enthesis with increased resistance to failure. STATEMENT OF SIGNIFICANCE: The musculoskeletal system is sensitive to its loading environment; this is of particular concern under conditions such as disuse, paralysis, and extended-duration space flight. Although changes to tendon and bone following paralysis are understood, there is a pressing need to clarify how unloading affects the bone-tendon interface (enthesis), which is the location most prone to tears and injury. We elucidated the effects of enthesis unloading in adult mice shoulders showing, for the first time, that unloading significantly increased the risk and extent of mechanical failure and was associated with structural changes across hierarchical scales. These observations provide new insight into the hierarchical features of structure and composition that endow the enthesis with resilience. This knowledge can be used to develop more targeted treatments to improve mobility and function.
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Affiliation(s)
- Alix C Deymier
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, USA.
| | - Andrea G Schwartz
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
| | - Zhounghou Cai
- Advanced Photon Source, Argonne National Lab, Argonne, IL, USA.
| | - Tyrone L Daulton
- Department of Physics, Washington University, St. Louis, MO, USA; Institute of Materials Science and Engineering, Washington University, St. Louis, MO, USA.
| | - Jill D Pasteris
- Department of Earth and Planetary Science, Washington University, St. Louis, MO, USA.
| | - Guy M Genin
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA.
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA; Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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45
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Boyle JJ, Soepriatna A, Damen F, Rowe RA, Pless RB, Kovacs A, Goergen CJ, Thomopoulos S, Genin GM. Regularization-Free Strain Mapping in Three Dimensions, With Application to Cardiac Ultrasound. J Biomech Eng 2019; 141:2705368. [PMID: 30267039 PMCID: PMC6298532 DOI: 10.1115/1.4041576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/21/2018] [Indexed: 12/17/2022]
Abstract
Quantifying dynamic strain fields from time-resolved volumetric medical imaging and microscopy stacks is a pressing need for radiology and mechanobiology. A critical limitation of all existing techniques is regularization: because these volumetric images are inherently noisy, the current strain mapping techniques must impose either displacement regularization and smoothing that sacrifices spatial resolution, or material property assumptions that presuppose a material model, as in hyperelastic warping. Here, we present, validate, and apply the first three-dimensional (3D) method for estimating mechanical strain directly from raw 3D image stacks without either regularization or assumptions about material behavior. We apply the method to high-frequency ultrasound images of mouse hearts to diagnose myocardial infarction. We also apply the method to present the first ever in vivo quantification of elevated strain fields in the heart wall associated with the insertion of the chordae tendinae. The method shows promise for broad application to dynamic medical imaging modalities, including high-frequency ultrasound, tagged magnetic resonance imaging, and confocal fluorescence microscopy.
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Affiliation(s)
- John J. Boyle
- Department of Biomedical Engineering,
Washington University in St. Louis,
St. Louis, MO 63130;
Department of Orthopaedic Surgery,Columbia University,
Black Building 1406, 650 W 168 Street,
New York, NY 10032
e-mail:
| | - Arvin Soepriatna
- Weldon School of Biomedical Engineering,
Purdue University,
206 S. Martin Jischke Drive, Room 3025,
West Lafayette, IN 47907
e-mail:
| | - Frederick Damen
- Weldon School of Biomedical Engineering,
Purdue University,
206 S. Martin Jischke Drive, Room 3025,
West Lafayette, IN 47907
e-mail:
| | - Roger A. Rowe
- Department of Mechanical Engineering and
Materials Science,
Washington University in St. Louis,
Jolley Hall, CB 1185, 1 Brookings Drive,
St. Louis, MO 63130
e-mail:
| | - Robert B. Pless
- Department of Computer Science,
George Washington University,
800 22nd Street NW Room 4000,
Washington, DC 20052
e-mail:
| | - Attila Kovacs
- Department of Internal Medicine,
Cardiovascular Division,
Washington University School of Medicine,
660 S. Euclid Avenue, CB 8086,
St. Louis, MO 63110
e-mail:
| | - Craig J. Goergen
- Mem. ASME
Weldon School of Biomedical Engineering,
Purdue University,
206 S. Martin Jischke Drive, Room 3025,
West Lafayette, IN 47907
e-mail:
| | - Stavros Thomopoulos
- Mem. ASMEDepartment of Orthopaedic Surgery,
Columbia University,
New York, NY 10032;
Department of Biomedical Engineering,Columbia University,
Black Building 1408, 650 W 168 Street,
New York, NY 10032
e-mail:
| | - Guy M. Genin
- Fellow ASME
Department of Biomedical Engineering,
Washington University in St. Louis,
St. Louis, MO 63130;
Department of Mechanical Engineering and
Materials Science,
Washington University in St. Louis,
St. Louis, MO 63130;
NSF Science and Technology Center
for Engineering Mechanobiology,
Washington University in St. Louis,
Green Hall, CB 1099, 1 Brookings Drive,
St. Louis, MO 63130
e-mail:
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46
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Liu J, Das D, Yang F, Schwartz AG, Genin GM, Thomopoulos S, Chasiotis I. Energy dissipation in mammalian collagen fibrils: Cyclic strain-induced damping, toughening, and strengthening. Acta Biomater 2018; 80:217-227. [PMID: 30240954 PMCID: PMC6510236 DOI: 10.1016/j.actbio.2018.09.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 08/29/2018] [Accepted: 09/17/2018] [Indexed: 02/04/2023]
Abstract
As the fundamental structural protein in mammals, collagen transmits cyclic forces that are necessary for the mechanical function of tissues, such as bone and tendon. Although the tissue-level mechanical behavior of collagenous tissues is well understood, the response of collagen at the nanometer length scales to cyclical loading remains elusive. To address this major gap, we cyclically stretched individual reconstituted collagen fibrils, with average diameter of 145 ± 42 nm, to small and large strains in the partially hydrated conditions of 60% relative humidity. It is shown that cyclical loading results in large steady-state hysteresis that is reached immediately after the first loading cycle, followed thereafter by limited accumulation of inelastic strain and constant initial elastic modulus. Cyclic loading above 20% strain resulted in 70% increase in tensile strength, from 638 ± 98 MPa to 1091 ± 110 MPa, and 70% increase in toughness, while maintaining the ultimate tensile strain of collagen fibrils not subjected to cyclic loading. Throughout cyclic stretching, the fibrils maintained a steady-state hysteresis, yielding loss coefficients that are 5-10 times larger than those of known homogeneous materials in their modulus range, thus establishing damping of nanoscale collagen fibrils as a major component of damping in tissues. STATEMENT OF SIGNIFICANCE: It is shown that steady-state energy dissipation occurs in individual collagen fibrils that are the building blocks of hard and soft tissues. To date, it has been assumed that energy dissipation in tissues takes place mainly at the higher length scales of the tissue hierarchy due to interactions between collagen fibrils and fibers, and in limited extent inside collagen fibrils. It is shown that individual collagen fibrils need only a single loading cycle to assume a highly dissipative, steady-state, cyclic mechanical response. Mechanical cycling at large strains leads to 70% increase in mechanical strength and values exceeding those of engineering steels. The same cyclic loading conditions also lead to 70% increase in toughness and loss properties that are 5-10 times higher than those of engineering materials with comparable stiffness.
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Affiliation(s)
- Julia Liu
- Aerospace Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Debashish Das
- Aerospace Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Fan Yang
- Aerospace Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Andrea G Schwartz
- Orthopaedic Surgery, Washington University, St. Louis, MO 60613, USA
| | - Guy M Genin
- Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130, USA; NSF Science and Technology Center for Engineering Mechanobiology, St. Louis, MO 63130, USA
| | - Stavros Thomopoulos
- Orthopedic Surgery, Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Ioannis Chasiotis
- Aerospace Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Abstract
On May 22, 2017, the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) hosted a roundtable on "Innovative Treatments for Enthesis Repair." A summary of the roundtable discussion, as well as a list of the extramural participants, can be found at https://www.niams.nih.gov/about/meetings-events/roundtables/roundtable-innovative-treatments-enthesis-repair. This paper reviews the challenges and opportunities for developing effective treatment strategies for enthesis repair that were identified at the roundtable discussion.
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Affiliation(s)
- Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,E-mail address for K.A. Derwin:
| | - Leesa M. Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY
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48
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Shen H, Jayaram R, Yoneda S, Linderman SW, Sakiyama-Elbert SE, Xia Y, Gelberman RH, Thomopoulos S. The effect of adipose-derived stem cell sheets and CTGF on early flexor tendon healing in a canine model. Sci Rep 2018; 8:11078. [PMID: 30038250 PMCID: PMC6056475 DOI: 10.1038/s41598-018-29474-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/06/2018] [Indexed: 12/28/2022] Open
Abstract
Intrasynovial tendon injuries are among the most challenging in orthopedics. Despite significant improvements in operative and rehabilitation methods, functional outcomes continue to be limited by adhesions, gap formation, and rupture. Adhesions result from excessive inflammation, whereas tendon gapping and rupture result from inflammation-induced matrix degradation and insufficient regeneration. Therefore, this study used a combined treatment approach to modulate inflammation with adipose-derived mesenchymal stromal cells (ASCs) while stimulating tendon regeneration with connective tissue growth factor (CTGF). ASCs were applied to the repair surface via cell sheets and CTGF was delivered to the repair center via porous sutures. The effect of the combined treatment was assessed fourteen days after repair in a canine flexor tendon injury model. CTGF, either alone or with ASCs, reduced inflammatory (IL1B and IL6) and matrix degrading (MMP3 and MMP13) gene expression, while increasing anti-inflammatory gene (IL4) expression and collagen synthesis compared to control repairs. The combined treatment was more effective than CTGF treatment alone, reducing the inflammatory IFNG and scar-associated COL3A1 gene expression and increasing CD146+ tendon stem/progenitor cells at the tendon surface and interior along the core suture tracks. Therefore, the combined approach is promising in promoting early flexor tendon healing and worthy of further investigation.
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Affiliation(s)
- Hua Shen
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Rohith Jayaram
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Susumu Yoneda
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Stephen W Linderman
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | | | - Younan Xia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Richard H Gelberman
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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49
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Richardson WJ, Kegerreis B, Thomopoulos S, Holmes JW. Potential strain-dependent mechanisms defining matrix alignment in healing tendons. Biomech Model Mechanobiol 2018; 17:1569-1580. [PMID: 30003433 DOI: 10.1007/s10237-018-1044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022]
Abstract
Tendon mechanical function after injury and healing is largely determined by its underlying collagen structure, which in turn is dependent on the degree of mechanical loading experienced during healing. Experimental studies have shown seemingly conflicting outcomes: although collagen content steadily increases with increasing loads, collagen alignment peaks at an intermediate load. Herein, we explored potential collagen remodeling mechanisms that could give rise to this structural divergence in response to strain. We adapted an established agent-based model of collagen remodeling in order to simulate various strain-dependent cell and collagen interactions that govern long-term collagen content and fiber alignment. Our simulation results show two collagen remodeling mechanisms that give rise to divergent collagen content and alignment in healing tendons: (1) strain-induced collagen fiber damage in concert with increased rates of deposition at higher strains, or (2) strain-dependent rates of enzymatic degradation. These model predictions identify critical future experiments needed to isolate each mechanism's specific contribution to the structure of healing tendons.
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Affiliation(s)
- William J Richardson
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Institute for Biological Interfaces of Engineering, Clemson University, Clemson, SC, USA
| | - Brian Kegerreis
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA.
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA.
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50
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Linderman SW, Shen H, Yoneda S, Jayaram R, Tanes ML, Sakiyama-Elbert SE, Xia Y, Thomopoulos S, Gelberman RH. Effect of connective tissue growth factor delivered via porous sutures on the proliferative stage of intrasynovial tendon repair. J Orthop Res 2018; 36:2052-2063. [PMID: 29266404 PMCID: PMC6013340 DOI: 10.1002/jor.23842] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023]
Abstract
Recent growth factor, cell, and scaffold-based experimental interventions for intrasynovial flexor tendon repair have demonstrated therapeutic potential in rodent models. However, these approaches have not achieved consistent functional improvements in large animal trials due to deleterious inflammatory reactions to delivery materials and insufficient induction of targeted biological healing responses. In this study, we achieved porous suture-based sustained delivery of connective tissue growth factor (CTGF) into flexor tendons in a clinically relevant canine model. Repairs with CTGF-laden sutures were mechanically competent and did not show any evidence of adhesions or other negative inflammatory reactions based on histology, gene expression, or proteomics analyses at 14 days following repair. CTGF-laden sutures induced local cellular infiltration and a significant biological response immediately adjacent to the suture, including histological signs of angiogenesis and collagen deposition. There were no evident widespread biological effects throughout the tendon substance. There were significant differences in gene expression of the macrophage marker CD163 and anti-apoptotic factor BCL2L1; however, these differences were not corroborated by proteomics analysis. In summary, this study provided encouraging evidence of sustained delivery of biologically active CTGF from porous sutures without signs of a negative inflammatory reaction. With the development of a safe and effective method for generating a positive local biological response, future studies can explore additional methods for enhancing intrasynovial tendon repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2052-2063, 2018.
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Affiliation(s)
- Stephen W. Linderman
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Susumu Yoneda
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Rohith Jayaram
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Michael L. Tanes
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Younan Xia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, 650 W 168 ST, Black Building 1408, New York 10025 New York
| | - Richard H. Gelberman
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
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